Kinins are vasoactive peptides and central neuromediators involved in cardiovascular control, pain and inflammation. Their effects are mediated by two G protein-coupled receptors: the constitutive B2 receptor (B2R) and the inducible B1 receptor (B1R) that is upregulated during tissue injury, in the presence of proinflammatory cytokines, bacterial endotoxins and diabetes. Diabetes has reached epidemic level and its etiology is complex. Diabetes mellitus worsens severe infections and increases mortality caused by hyperbacteremia resistant to therapeutic control and management in intensive care units. Mortality is largely secondary to the occurrence of disseminated intravascular coagulation (DIC). This project examines the role of B1R in DIC in a model of type 1 diabetes induced by streptozotocin (STZ) (Article 1) and insulitis (Article 2). DIC was induced by injection of lipopolysaccharide (LPS, 2 mg/kg i.p.) four days after treatment with STZ (65 mg/kg, i.p.). In the first article, we have shown a significant increase in edema and vascular permeability (Evans blue) in kidney, lung, heart and liver in rats treated with LPS and/or STZ, increasing the haemoconcentration and the development of hypercoagulability state. Also, we showed the presence of thrombus formation and tissue damage by histological studies, and increased expression of B1R in the heart, kidney and platelets. Treatment with the B1R antagonist, SSR240612, alleviated all those abnormalities, in addition to reducing hyperglycemia in STZ rats, LPS-induced hyperthermia and improving survival. The beneficial effects of SSR240612 were reproduced by the inhibition of iNOS with 1400W and of COX-2 with niflumic acid, suggesting that the mediators of these proinflammatory enzymes act downstream to B1R.
In the second article, STZ rats were treated with SSR240612 (10 mg/kg/d, per os) from day 4 to day 7. This B1R antagonist blocked the infiltration of the pancreas by macrophages andTCD4+ lymphocytes which express B1R. The antagonist also prevented the increased expression of iNOS, TNF-α, B1R and TRPV1 in the pancreas of STZ-diabetic rats. The treatment with the B1R antagonist limited the loss of Langerhans β cells, which improved plasma insulin and normalized hyperglycemia.
These studies highlight a primary role for B1R in lethality associated with septic shock, thrombosis and insulitis. Therefore, kinin B1R is a promising therapeutic target in the treatment of diabetes and its complications.